Long-Term Disability Insurance Claims: Overcoming Denials Related to Spinal Injuries [Part II]

J.P. Gonzalez-Sirgo
Founder of J.P. Gonzalez-Sirgo, P.A.

This is the second installment of our two-part blog post discussing the special challenges related to bringing long-term disability insurance claims arising from back problems.  Part I of this blog focused on the most common types of back injuries that result in long-term disability insurance claims while this installment focuses on actions a claimant should take to protect his contractual and legal right to benefits under a private long-term disability insurance policy. 

Many back-related disabilities must be established without compelling objective medical evidence.  Strong claims might be approved based on the medical diagnosis of severe degenerative disc disease along with impaired functional capacity, which reveals a significant limitation on range of motion.  The challenge is that in most cases the objective evidence could go either way depending on the individual.  It is not uncommon that one person is able to work while the other would be incapacitated based on the same medical evidence.  In these borderline cases, claimants need to build compelling appeals of their denials.  The following steps can improve your ability to present a compelling case on appeal.

Create a Strong Medical Record: Prompt medical attention is essential, which includes attending scheduled appointments with physicians and specialists.  Treating doctors and specialists generally will order diagnostic imaging, such as CT scans, X-rays, and MRIs.  When claimants fail to comply with basic follow-up for diagnostic imaging, treatment, and rehabilitation, this will be used by the insurance carrier to deny a long-term disability insurance claim.  Claimants should make sure to follow all of the following common instructions.

  • Fill and take prescribed medication
  • Get rest
  • Attend physical therapy appointments
  • Show up for doctor’s appointments

While a painful back problem is a physical condition, the limitations and intense pain often result in psychological symptoms like depression and stress, you also should seek the care of a mental health professional and disclose these issues.

Obtain other evidence and opinions: Because a disability insurance claim essentially turns on the impact of a back injury on your functional capacity, information provided by those who know you best also can be effective evidence.  Family, friends, co-workers, and colleagues see and interact with you on a regular basis, so they can provide a compelling picture of your physical limitations and the mental health-related impact of your spinal problem.

Ensure Documentation of Physical/Mental Limitations: Claimants should request that their treating doctor and/or specialist evaluate their functional limitations with a Residual Functions Capacity form or a narrative report.  Limitations involving sitting, stooping, carrying, bending, walking and standing should be noted on the report.  Additionally, secondary limitations should be reported, such as difficulty concentrating or fatigue.  These secondary symptoms are especially important if your doctor expects that you might need to miss work often or that you will need periodic rest periods during the day.  If your doctor puts forth reasonable effort in documenting these limitations, these details can strengthen a long-term disability insurance claim.

Seek Experienced Long-Term Disability Insurance Claims Attorney: While private carriers often are cooperative in providing temporary benefits under a long-term disability insurance policy, this initial cooperation often disappears before an award of long-term disability insurance benefits.  Whether you are initially denied temporary benefits or you suddenly have your benefits terminated, an experienced disability insurance claims attorney can guide you through the minefield of insurance company hurdles and traps.  Our law firm protects the contractual and legal rights of our clients while pursuing the full measure of benefits under an insurance policy.

You can reach Miami Insurance Claims Lawyer J.P. Gonzalez-Sirgo by dialing his direct number at (786) 272-5841, calling the main office at (305) 461-1095, or Toll Free at 1 (866) 71-CLAIM or email Attorney Gonzalez-Sirgo directly at [email protected].

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